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<p>The optimal treatment for poor-grade aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. This study compared outcomes of microsurgical treatment (MST) and endovascular treatment (EVT) in poor-grade aSAH. We consecutively enrolled patients with poor-grade aSAH admitted to the Chinese Multicenter Aneurysm Database (CMAD) between January 2017 and December 2020. After 1:1 propensity score matching (PSM), clinical outcomes and in-hospital complications were compared between MST and EVT. Generalized estimating equations (GEE) assessed outcome associations; Kaplan–Meier and Cox models analyzed survival and mortality predictors. Of 1,008 patients, 373 MST cases were matched to 373 EVT cases. Mortality was similar between groups (28.1% vs. 27.5%, <i>p</i> = 0.075). EVT was associated with lower rates of dependent survival at discharge (41.8% vs. 59.1%, adjusted OR 0.584, <i>p</i> &lt; 0.001) and at 2 years (21.3% vs. 31.8%, adjusted OR 0.574, <i>p</i> = 0.026), shorter length of stay (17 vs. 20 days, adjusted OR 0.053, <i>p</i> = 0.025), and fewer intracranial infections (4.8% vs. 13.9%, adjusted OR 0.248, <i>p</i> = 0.001). However, hydrocephalus was more frequent in the EVT group (9.7% vs. 4.6%, adjusted OR 2.294, <i>p</i> = 0.001). Risk factors for mortality differed between groups. In this multicenter observational cohort of patients with poor-grade aSAH, MST and EVT were associated with similar survival, whereas EVT was associated with more favorable functional outcomes, shorter hospitalization, and fewer intracranial infections, but a higher incidence of hydrocephalus. These findings support individualized treatment selection while highlighting the need for cautious interpretation given potential residual confounding.</p>

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Comparison of microsurgical and endovascular treatment outcomes in poor-grade aneurysmal subarachnoid hemorrhage: a multicenter cohort study

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Xiuhu An,
  • Xinwang Cai,
  • Ruyi Wang,
  • Ying Wang,
  • Zhenbo Liu,
  • Wentao Dong,
  • Yiyang Sun,
  • Yan Zhao,
  • Xinyu Yang,
  • Yanfen Chai,
  • Feng Guo

摘要

The optimal treatment for poor-grade aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. This study compared outcomes of microsurgical treatment (MST) and endovascular treatment (EVT) in poor-grade aSAH. We consecutively enrolled patients with poor-grade aSAH admitted to the Chinese Multicenter Aneurysm Database (CMAD) between January 2017 and December 2020. After 1:1 propensity score matching (PSM), clinical outcomes and in-hospital complications were compared between MST and EVT. Generalized estimating equations (GEE) assessed outcome associations; Kaplan–Meier and Cox models analyzed survival and mortality predictors. Of 1,008 patients, 373 MST cases were matched to 373 EVT cases. Mortality was similar between groups (28.1% vs. 27.5%, p = 0.075). EVT was associated with lower rates of dependent survival at discharge (41.8% vs. 59.1%, adjusted OR 0.584, p < 0.001) and at 2 years (21.3% vs. 31.8%, adjusted OR 0.574, p = 0.026), shorter length of stay (17 vs. 20 days, adjusted OR 0.053, p = 0.025), and fewer intracranial infections (4.8% vs. 13.9%, adjusted OR 0.248, p = 0.001). However, hydrocephalus was more frequent in the EVT group (9.7% vs. 4.6%, adjusted OR 2.294, p = 0.001). Risk factors for mortality differed between groups. In this multicenter observational cohort of patients with poor-grade aSAH, MST and EVT were associated with similar survival, whereas EVT was associated with more favorable functional outcomes, shorter hospitalization, and fewer intracranial infections, but a higher incidence of hydrocephalus. These findings support individualized treatment selection while highlighting the need for cautious interpretation given potential residual confounding.